Patient Case Presentation

1. Patient Case Presentation Neurosurgery Red Service Gabriel Zada, MD Sean McNatt, MD LAC-USC Medical Center May 3, 2006

2. Patient J.A. • History of Present Illness: • 22 month old female I • Irritability, nausea/vomiting, decreased p.o. intake for 6 days prior to admission • Low grade fever per parents • Multiple visits to emergency room + clinics over last week, got intravenous fluids and parents told her illness was viral

3. Patient J.A. • History of Present Illness (continued): • Presented again to Pediatrics ER with lethargy, altered mental status • Bradycardic to pulse of 70s, hypertensive • Intubated and sedated in ER for airway protection • No recent seizures, no sick contacts • Past Medical History: • Past medical and surgical history unremarkable • Term birth, uncomplicated • Normal developmental milestones

4. Patient J.A. • Physical Exam: • Patient intubated, sedated • Somnolent but arousable • Regards examiner, not following commands • Pupils briskly reactive and equal • Extraocular movements intact • Tone normal • Moving all extremities with full power • Normocephalic, no external signs of trauma

5. CT Imaging

27. Initial Management • Patient admitted to Neurosurgical ICU • Right ventriculostomy placed • Initial ICPs in the 20s, normalized with drainage • CSF yellow, proteinaceous • High ventriculostomy output (150 cc/12 hours) • Patient transferred to CHLA for definitive management

28. MRI Brain